口服降糖药小讲课.pptVIP

* * * Biguanide (二甲双胍) has additional clinical benefits such as weight stabilisation/降低, 降低 in hypertriglyceridaemia, lowering plasma 脂肪酸 和 HDL cholesterol. Common adverse 事件 include abdominal discomfort 和 other gastrointestinal adverse effects. The most serious adverse 事件 associated with 二甲双胍 is lactic acidosis; although rare, the mortality rate is high.1 磺脲类s (e.g. 格列美脲, glipizide) have been extensively used for the 疗法 of 2型糖尿病 for n早期50 年. 低血糖 is the most common adverse effect of 磺脲类 疗法. 体重增加is regarded as a class effect of 磺脲类 疗法, typically amounting to 1–4kg 和 stabilising after approximately 6 months. 噻唑烷二酮类(e.g. 砒格列酮, 罗格列酮) improve whole-body 胰岛素 sensitivity via multiple actions on gene regulation. 噻唑烷二酮类are associated with fluid retention with increased plasma volume, a reduced haematocrit and a decrease in haemoglobin concentration.1 Meglitinides (e.g. nateglinide, repaglinide) have a rapid onset of action 和 a short duration of hypo血糖 effect which make them suitable for pre-prandial administration. A small increase in bodyweight can be expected in 患者. Among 胰岛素 therapies (e.g. 胰岛素 aspart, 胰岛素 glulisine), options include rapid-acting, intermediate-acting, and long-acting human 胰岛素 preparations. 体重增加and 低血糖 are associated with 胰岛素 疗法.2 ?-glucosidase 抑制剂 (e.g. 阿卡波糖, miglitol) do not cause 体重增加, can reduce post-prandial hyper胰岛素aemia and have lowered plasma triglyceride concentrations in some studies. Their use has been limited by adverse gastrointestinal effects.1 Pramlintide, an injected peptide used in combination with 胰岛素, can reduce 胰岛素 dose and bodyweight. Nausea is the most common side effect.3 DPP-4 抑制剂 (e.g. sitagliptin, vildagliptin) are generally well tolerated and 不影响体重. Long-term data on 心血管outcomes and safety are needed.4 GLP-1 agonists (e.g. 艾塞那肽, liraglutide) have shown a favourable effect on weight, are not associated with 低血糖, but common 副反应 include gastrointestinal disturbances.4 Krentz A and Bailey C. Drugs 2005;65:385–411. Carver C.